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Running head: DELIVERY 0

Critical Thinking: Healthcare Delivery

Fallon Urquhart

Course Number (PJM580) – Capstone- Project Management

Colorado State University – Global Campus

Dr. Douglas Smith

September 20, 2020

Healthcare Delivery

Project management skills play a significant role in managing a service type project, especially one that has an international component. The project in question entails rolling out specialty-specific electronic health records (EHR) in Kenya, an African country that seeks to adopt a patient-centered care delivery model aided by a specialty EHR. This specific EHR will be in Obstetrics and Gynecology Practice, as the country seeks to improve maternal health and childbirth. According to a 2011/2012 report entitled Maternal and Child Health: Kenya, maternal mortality in the country remained at an all-time high of 488 maternal deaths per 100,000 live births (See Appendix A). The implementation of the specialty EHR will change the delivery of healthcare in the area of obstetrics and gynecology practice. This outcome will be actualized when based on new functionality and use where EHRs have tremendously changed the dynamics of patient-clinician interaction via telemedicine, clinician-patient email, and virtual consults (Evans, 2016). This service type project has an international component because the specialty EHR vendor is outsourced from abroad.

Project Initiation

The initiation or the formal authorization of the specialty EHR will be done by the Government of Kenya through the Ministry of Health (MOH) in conjunction with the project’s main donor the World Bank. The project initiation process will be done by general management in consultation with project management to avoid the potential failure that occurs when the two do not work together. The glaring of materials regarding the pre-execution phase in the PBOK Guide seems to reinforce the notion that only general managers rather than project managers should be engaged in processes like project initiation, often leading to project failure (Stretton, 2018). It is at this stage where activities like project identification, the setting of project objectives and goals, feasibility study, determination of preliminary resources, development of a budget and project schedule, and constitution of the project team are done.

Project Planning

The project planning of a service type project which has an international component is a fairly complex process. Planning is an integral component of a project, especially when it comes to project performance and ultimate project success (Naeem, 2018). In this particular project, the project managers prepared a comprehensive project that will lead to the project success if followed. The plan touches on numerous items including:

Project Statement of Work (SOW)

The project team came up with an elaborate statement of work. The SOW began with introduction that introduces the project as the implementation of specialty HER in obstetrics and gynecology practice across Kenya’s level 3 to 5 hospitals to improve the delivery of patient-centered care, realizing better outcomes in maternal healthcare and childbirth. The SOW outlines the major parties to this project as Kenya’s Ministry of Health, World Bank, and EPIC reputable global vendor/provider of EHR programs. The $3 million-project will entail procurement of the specialty EHR, its installation, training health providers on its use by experts from EPIC, and eventual handover to Kenya’s MOH. The entire project will take eight months. Once the project is complete, the new delivery method is expected to enable interaction between patients and their physician’s, to provide a platform where patient information regarding that specialty will be accessible to physicians at any facility across the country, and the system will have higher capabilities like scheduling and bill pap smears, calculate due dates, track contraception, and perform ultrasound analysis.

Business Case

A succinct justification was given for implementing the specialty EHR project in Kenya. First, a feasibility study showed by Kenya, most hospitals have the necessary infrastructure and competent staff running of the project would be a relatively easy affair. Second, most hospitals are using electronic medical records (EMR), which do not allow the sharing of patient information across health facilities. Therefore, the rolling out the specialty EHR will enable physicians to access their patients’ information regarding obstetrics and gynecology history irrespective of the hospital one visits, leading to better maternal and childbirth outcomes. Like in any other case, this project is touted to beneficial since EHRs enable the achievement of a project’s vision by improving efficiency and increases the quality of healthcare by streamlining healthcare processes (Jetté, 2019). This kind of streamlining healthcare process is what is needed in this new healthcare delivery method, which seeks to be patient-centered.

Agreements

Several memoranda of understanding (MoU) have been signed to pave way for the project’s implementation. The first MoU signed was signed is between Kenya through its Ministry of Health and World which has agreed to fund the entire project. The second agreement is a contract signed between EHR software, provide the expertise needed, undertake training to build local capacity on the EHR use, do maintenance, and later hand over the project, once it is fully operationalized.

Enterprise Environmental Factors

The key enterprise environmental factors (EEF) identified for this project include healthcare-seeking behaviors among Kenya, the limited number of levels 3,4,5 hospitals in the country, potential incompatibility of specialty EHR with other existing EHRs, ack of local expertise in EHRs, government regulations, and other institutional barriers.

Organizational Process Assets

The PMBOK Guide defines organizational process assets as ‘plans, policies, and process, knowledge bases, and procedures’ which are specifically used by a performing organization. In this project, it was agreeable that Kenya’s Healthcare Act 2017, which guides the running of healthcare in Kenyan hospital; and the Reproductive Healthcare Bill 2019, which manages obstetrics and gynecology practice that falls under reproductive health.

Project Charter

The project management team came up with a project charter that gave authority for the existence of initiation of this project. The charter specifically gave the project manager the power to use organizational resources to implement the project. The project charter stipulates what the project’s scope with be, the project development, its objectives, and its end in defining the roles and responsibilities of all the parties involved in the project.

Stakeholder Analysis and Management

The first category of stakeholders in this project is Kenya’s MoH led by the cabinet secretary, permanent secretary, and director-general of health, who leads a group of experts from the ministry, some of who form part of the project team. The second stakeholder is the World Bank, which is keen to support Africa, in this case, Kenya is offered funding to change its healthcare delivery methods to reduce maternal and infant mortality rates. The last stakeholder is EPIC, an overseas EHR solution provider that has worn tender to implement the project deploying the specialty EHR to the country’s obstetrics and gynecology practice environment.

Traceability Matrix

The PM constructed a traceability matrix to ensure that the project’s requirements, scope, and deliverables remain the same when compared to its baseline. Appendix B contains the project’s traceability matrix.

Project Scope Statement

The project scope statement states that this project deals with implementing specialty EHR in obstetrics and gynecology practice. What this means is the project is strictly tailored for the specialty and cannot be used in any other practice like cardiology. The project is confined to level 3 to level 5 hospitals because health facilities tend to have superior systems that can support this type of EHR.

Consideration Requirements

Service type projects with an international component tend to have unique considerations in project initiation and planning. The first thing to consider is the consumer behaviors of the receipt country, and in this case, it is Kenya’s healthcare-seeking behaviors to ensure that the EHR will be applicable. The second thing is to consider is the existing technologies to ensure compatibility of the new service with the existing bundle of services. Lastly, the lack of local expertise is another item to consider because it can frustrate the whole exercise of implementing the project due to the inadequacy of competent personnel.

Conclusion

The goal with creating the specialty EHR project is to help increase the healthcare as a whole where it is otherwise depleting. Through this project and implementation Kenya hospitals are able to adopt a more patient-centered are system in specific areas such as obstetrics and gynecology practices. With this implemented service project, hospitals will be able to increase the healthcare of new borns, lowering the mortality rate currently seen. Even though the project takes place in Africa, this is a service that can be outsourced to other areas allowing for a positive result for all healthcare industries.

References

Evans, R. S. (2016). Electronic health records: then, now, and in the future. Yearbook of medical informatics, (Suppl 1), S48.

Jetté, N., & Kwon, C. S. (2019). Electronic Health Records—A System Only as Beneficial as Its Data. JAMA network open, 2(9), e1911679-e1911679.

Naeem, S., Khanzada, B., Mubashir, T., & Sohail, H. (2018). Impact of Project Planning on Project Success with Mediating Role of Risk Management and Moderating Role of Organizational Culture. International Journal of Business and Social Science, 9(1), 88-98.

Maternal and Child Health: Kenya. Retrieved from, https://www.who.int/pmnch/media/membernews/2011/20121216_kenyaparliament.pdf

Stretton, A. (2018). Increasing project management involvement in pre-execution phases of projects. PM World Journal, 7.

Appendix A

Appendix B

Traceability Matrix